437 Progressive Vs Non-Progressive Onset of Chronic Gvhd After ATG Prophylaxis Is Highly Predictive of Outcome

Track: Contributed Abstracts
Saturday, February 16, 2013, 6:45 PM-7:45 PM
Hall 1 (Salt Palace Convention Center)
David Jones, MD , Blood and Bone Marrow Transplant Program, Tom Baker Cancer Centre/Foothills Hospital, Calgary, AB, Canada
Muhd Zakaria, MBChB, MMED , Blood and Bone Marrow Transplant Program, Tom Baker Cancer Centre/Foothills Hospital, Calgary, AB, Canada
Maggie Yang , Blood and Bone Marrow Transplant Program, Tom Baker Cancer Centre/Foothills Hospital, Calgary, AB, Canada
Loree Larratt, MD FRCPC , Cross Cancer Institute, Edmonton, AB, Canada
Robert Turner, MD , Cross Cancer Institute, Edmonton, AB, Canada
Chris Brown, MD , Blood and Bone Marrow Transplant Program, Tom Baker Cancer Centre/Foothills Hospital, Calgary, AB, Canada
Nizar Bahlis, MD FRCPC , Blood and Bone Marrow Transplant Program, Tom Baker Cancer Centre/Foothills Hospital, Calgary, AB, Canada
Mary Lynn Savoie, MD, FRCPC , Blood and Bone Marrow Transplant Program, Tom Baker Cancer Centre/Foothills Hospital, Calgary, AB, Canada
Andrew Daly , Blood and Bone Marrow Transplant Program, Tom Baker Cancer Centre/Foothills Hospital, Calgary, AB, Canada
Michelle Geddes , Blood and Bone Marrow Transplant Program, Tom Baker Cancer Centre/Foothills Hospital, Calgary, AB, Canada
Jan Storek, MD, PhD , Blood and Bone Marrow Transplant Program, Tom Baker Cancer Centre/Foothills Hospital, Calgary, AB, Canada
Nancy Zacarias, MD , Blood and Bone Marrow Transplant Program, Tom Baker Cancer Centre/Foothills Hospital, Calgary, AB, Canada
Peter Raymond Duggan, MD , Blood and Bone Marrow Transplant Program, Tom Baker Cancer Centre/Foothills Hospital, Calgary, AB, Canada
Diana Quinlan, RN , Blood and Bone Marrow Transplant Program, Tom Baker Cancer Centre/Foothills Hospital, Calgary, AB, Canada
Douglas Stewart, MD , Blood and Bone Marrow Transplant Program, Tom Baker Cancer Centre/Foothills Hospital, Calgary, AB, Canada
James A Russell, MA, MB , Blood and Bone Marrow Transplant Program, Tom Baker Cancer Centre/Foothills Hospital, Calgary, AB, Canada
The NIH chronic graft versus host disease (cGVHD) consensus statement emphasizes the importance of distinguishing acute from cGVHD based on clinical features rather than time. The proposed assessment of cGVHD severity appears to be prognostically important, but the relevance of categories and type of onset remains controversial. We retrospectively analyzed a homogeneously treated population of 600 patients transplanted between 1999-2010 with fludarabine 50 mg/m2 daily X 5, IV busulfan 3.2 mg/kg daily x 4, ATG (Thymoglobulin, Genzyme - total dose of 4.5 mg/kg). An additional 287 patients (48%) received additional TBI 200cGy x 2.  In this cohort, 245 patients (47%) had non-progressive cGVHD (NP-cGVHD) arising either de novo (n = 221) or after stopping primary immunosuppression (n = 24). In 71 patients (12%) progressive cGVHD (P-cGVHD) arose during systemic therapy for grade II-IV acute GVHD and 284 (41%) had no cGVHD. Patient and transplant factors were similar across all groups. Median followup was 84 (range 22- 161) months. The 5-year non-relapse mortality was 40% for patients with P-cGVHD compared with 11% for NP-cGVHD (p<0.0001) and 12% for no cGVHD (p<0.0001).  Patients with no cGVHD had more relapse (38%) than those with P-cGVHD (28%, p = 0.02) and P-cGVHD (27%, p= 0.002).  Overall survival for patients with no cGVHD was 61% vs 50% for P-cGVHD (p = 0.005) and 69% for NP-cGVHD (p = 0.02).  Disease free survival was 54% vs 43% (p = 0.003) and 65% (p = 0.003), respectively.  The median time on systemic immunosuppression for the 174 NP-cGVHD patients (71%) who required treatment was 273 days versus 398 days for all patients with P-cGVHD (p = ns). In conclusion, we propose that this simple means of classifying cGVHD is highly predictive of important transplant outcomes. It remains important both to prevent acute GVHD (and thus P-cGVHD) and yet take advantage of the graft-vs-malignancy effect conferred by NP-cGVHD.
See more of: Poster Session 2: GVH/GVL
See more of: Contributed Abstracts
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